Non-invasive physical therapy as salvage measure for ischemic skin flap:A literature review

This review focuses on the available evidence regarding the molecular mechanisms and treatment potential of several non-surgical physical therapies for managing flap ischemia to propose a non-invasive,economical,and simple treatment to improve flap survival.A review of the literature was conducted on the topics of various non-invasive methods for the treatment of ischemic necrosis of the distal end of the flap between 1988 and 2019.A total of 52 published studies were reviewed on the applications of hyperbaric oxygen therapy,electrical stimulation therapy,heat stress pretreatment,phototherapy,and vibration therapy to manage skin flap necrosis.The underlying molecular mechanisms of these physical therapies on revitalizing the dying skin flaps were discussed and preliminary clinical uses of these therapies to salvage the necrotic skin flaps were pooled and summarized for clarifying the safety and feasibility of these methods.Various physical therapy regimens have been ushered to manage necrotic development in cutaneous flaps.With the refinement of these new technologies and enhancement of related basic science research on vascular revitalization,the prevention and treatment of flap ischemia will enter a new era.

Study on Different Types of Skin Flap Transplantation to Repair Forefoot Damaged Injury

Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their clinical data were retrospectively analyzed.All the selected patients received skin flap transplantation and repair,of which 26 patients received free myocutaneous flap transplantation and repair,and were treated as group A.The other 36 patients underwent retrograde foot flap transplantation and repair.They were taken as group B,and the clinical treatment methods and curative effects were summarized.Results Among the 26 patients in group A,the skin flaps of 21 patients survived completely,while those of the other 5 patients showed partial necrosis at the edge of the skin flaps.They were treated with free skin grafting and healed after regular dressing change.All the skin flaps survived.Follow-up for at least 6 months showed that 11 patients had mild claudication and skin flap sensation was slightly poor.Among the 36 patients in group B,only 2 cases suffered from distal partial necrosis after the operation,which was caused by large tension after dorsum pedis flap transplantation.After systematic treatment and regular dressing change by doctors,the flaps of 2 patients healed.In addition,venous reflux disorder occurred in 3 patients with medial saphenous nerve nutrient vessel flap of the foot,which was related to swelling factors.The flaps of other patients survived,healed well and did not show infection symptoms.Conclusion According to the actual condition of patients with forefoot damage,the flap repair method is formulated,which has good short-term and long-term therapeutic effects and plays an important role in repairing forefoot damage.

The improvement of living quality for the patient with carcinoma of esophagus: Reconstruction for the defect of pharynx and cervical esophagus with inferior antebrachial skin flap on the basis of retaining the laryngeal function

Objective To investigate the effect of reconstruction for inferior pharyngeal and cervical esophagus defect with inferior antebrachial skin flaps on the living quality of patients after surgery. Method Perform radical operation of the tumor, but retain larynx and trachea. Free antebrchial skin flaps were used to reconstruct the defect of inferior pharynx and cervical esophagus. Roll the skin flap to form a skin tube, and then carry out anastomosis with floor of mouth and cervical esophagus. Result The laryngeal function was retained after surgery. And permanent orifice of trachea was unnecessary. The effect was satisfying. The vocalization wasn’t affected and food-intake through oral was normal in the 2 patients followed up. Conclusion It is a feasible way to reconstruct the inferior pharynx and cervical esophagus defect caused by radical operation of the tumor at pharynx and cervical esophagus. It can improve the living quality of patients effectively.

Facial Reconstruction with Combined Facial,Neck and Occipital Skin Flap Transplantation

To treat large facial defect (more than 6 cm×4 cm in diameter ) or a wound with bone exposure to atmosphere by less traumatic, easier healing reconstruction method, a pedicle flap including facial, neck, posterior auricle and occipital skin flap was designed and transferred, one by one, to repair facial defect as well as other flap donor sites, but occipital skin flap was only used to cover posterior auricle area. After 2-3 years follow up, well healed skin flaps with good color, elasticity and sensation were observed in all 16 patients. It is concluded that this method is effective and practical.

Primary Observations on the Influence of ^(60)Co Local Irradiation on Free Skin Flaps

Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14cm×6cm to 8cm×4cm. These flaps were exposed to 60Co radiation ranging 40-69 Gy. Results Observation during irradiation, no visible changes of skin flaps and oral mucous membrane were detected, when irradiation dose was within 40 Gy; some changes may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations were found in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation 2 years after irradiation, rib necrosis happened in 29 skin flaps. Hairs were found on 15 of 29 flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradiation at the dose of 60 Gy.

Biomaterial Scaffolds for Improving Vascularization During Skin Flap Regeneration

Over the past few decades,biomaterials have made rapid advances in tissue engineering.In particular,there have been several studies on vascularization during skin flap regeneration for plastic surgery.From the perspective of function,the biomaterials used to improve the vascularization of skin flaps are primarily classified into two types:(1)electrospun nanofibrous membranes as porous scaffolds,and(2)hydrogels as cell or cytokine carriers.Based on their source,various natural,synthetic,and semi-synthetic biomaterials have been developed with respective characteristics.For the ischemic environment of the flap tissue,the therapeutic effect of the combination of biomaterials was better than that of drugs,cytokines,and cells alone.Biomaterials could improve cell migration,prolong the efficacy of cytokines,and provide an advantageous survival environment to transplanted cells.

The First Case of Free Radial Forearm Skin Flap:A 40-Year Follow-Up Study

Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case presentation In this case,a female patient underwent RFSF surgery in 1979.In 2016 and 2018,two interviews were held to evaluate her subjective postoperative experience.In addition,overall donor site evaluation was conducted based on general health checkups and tests;tests for appearance,tactile sensitivity,muscle strength,and motor function;and CTA.Results The flap survived well,and the donor site recovered without hand necrosis in the 1970s.In 2018,the patient was in good health condition and expressed her satisfaction with the surgery.The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction;in the evaluation of hand and finger function,there was no point where functional reduction of the donor site was noted.CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.Conclusion After a nearly 40-year follow-up,the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes.The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.

Application of free vein skin flap on the anterior aspect of wrist in the case of finger injury with vessel and skin defect

Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.

Repair of facial skin defect with a skin flap of SMAS pedicle

To report a method of repair facial skin defects with a skin flap of SMAS pedicle.Methods According to the size of defect of skin,design a skin flap with SMAS pedicle for repair of defect.Results The method has been successfully applied for skin defects of eyelid and lip in 14 cases with satisfied results.The area of the largest flap was 5 cm×3 cm.Conclusion Repairing facial defects such as eyelid skin defect or lip skin defect with skin flap of SMAS pedicle is a very good method.The flap has a good blood supporting and satisfactory color and flexibility.5 refs,6 figs.

New advances in the mesenchymal stem cells therapy against skin flaps necrosis

Mesenchymal stem cells(MSCs), multipotential cells that reside within the bone marrow, can be induced to differentiate into various cells, such as osteoblasts, adipocytes, chondrocytes, vascular endothelial progenitor cells, and other cell types. MSCs are being widely studied as potential cell therapy agents due to their angiogenic properties, which have been well established by in vitro and in vivo researches. Within this context, MSCs therapy appears to hold substantial promise, particularly in the treatment of conditions involving skin grafts, pedicle flaps, as well as free flaps described in literatures. The purpose of this review is to report the new advances and mechanisms underlying MSCs therapy against skin flaps necrosis.

Role of adipose-derived stromal cells in pedicle skin flap survival in experimental animal models

The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adiposederived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.

Repair of necrosis and defects of penile skin with autologous free skin flap

我们描述了撕裂的一个 27 岁的盒子和创伤的 degloving 与广泛的阴茎皮肤坏死阴茎。在全身麻醉下面，施主皮肤部分根据阴茎皮肤的缺点区域是从下肢的 resected。然后砍接枝的形状被砍， sutured 到有紧张的人质皮肤缺点和 enswathed。阴茎的手术后的外观和功能是令人满意的。它是建议从下肢的相应免费皮瓣对阴茎皮肤修理合适并且对在令人满意的勃起和形状的耐心的结果有益。

Hyperbaric oxygen therapy for skin flap blood flow disorder: a case report

A female patient at the age of 17 received dilator implant on the right part of her face to prepare skin flap for her facial scar.The skin flap was in good conditions before scar cutting,but showed poor blood circulation after being transferred.Hyperbaric oxygen therapy was given at 0.2 MPa(2ATA) in double pure oxygen cabins for 90 min every day for 10 d.The skin flap showed in sound viability and sound blood circulation after the treatment.Hyperbaric oxygen therapy can be used to treat blood circulation disorder in transferred skin flap.

Hyperbaric Oxygen Therapy of Ischemic Cranial Skin Flap: Case Report and Review of the Literature

Hyperbaric Oxygen Therapy (HBOT) is a medical procedure and therapeutic modality that utilizes 100% oxygen. HBOT has been used various medical conditions such as progressive necrotizing fasciitis, peripheral arterial insufficiency, and diabetic wounds of the lower extremities. The case report reported here describes the usage of HBOT as an adjunctive “rescue” measure to salvage a patient’s cranioplasty scalp flap after flap ischemia was noted 2 days post-operatively. Patient is a 54 year-old caucasian female who presented to our facility with symptoms of a left MCA infarct. CT and MRI of her brain revealed a left MCA infarct with hemorrhagic stroke with significant cerebral edema, and midline shift. She was taken to the operating room for a left decompressive hemi-craniectomy. She had cranioplasty utilizing native bone flap delayed fashion. She had wound infection after cranioplasty which required removal of native bone. After appropriate treatment for infection, she had cranioplasty utilizing prosthetic Biomet implant. Post-cranioplasty, patient developed ischemic cranial flap. This was recognized within 48 hrs and HBOT was implemented. She has a successful rescue of the ischemic cranial flap after she received 14 consecutive treatments over two weeks. In our knowledge, this is the first successful treatment of HBOT reported after prosthetic cranioplasty for scalp flap ischemia.

Effects of hyperbaric oxygen preconditioning on ischemia-reperfusion inflammation and skin flap survival

Background Hyperbaric oxygen preconditioning （HBO） is a new method of ischemia preconditioning. In this study, we examined its effects on skin flap survival and the mechanisms involved. Methods Thirty-six rats were divided into three groups： HBO preconditioning, control, and sham groups. An extended epigastric adipocutaneous flap based on the right superficial epigastric artery and vein was raised. A 3-hour period of flap ischemia was induced by clamping the pedicle vessels with a microvascular clamp. At the end of ischemia induction, the clamp was removed and the flap was resutured. Rats in the HBO preconditioning group were treated with HBO four times before surgery. Microcirculation in the skin flap was measured on postoperative days 1, 3 and 5. The size of the flap was measured on postoperative day 5, before the animals were sacrificed. Samples of the skin flap were prepared and stained with hematoxylin and eosin. The levels of tumor necrosis factor （TNF）-α, interleukin （IL）-1β, and IL-6 in the flap samples were measured.

Protective effect of hydrogen-rich saline on ischemia/reperfusion injury in rat skin flap

Objective: Skin damage induced by ischemia/reperfusion (I/R) is a multifactorial process that often occurs in plastic surgery. The mechanisms of I/R injury include hypoxia, inflammation, and oxidative damage. Hydrogen gas has been reported to alleviate cerebral I/R injury by acting as a free radical scavenger. Here, we assessed the protective effect of hydrogen-rich saline (HRS) on skin flap I/R injury. Methods: Abdominal skin flaps of rats were elevated and ischemia was induced for 3 h; subsequently, HRS or physiological saline was administered intraperitoneally 10 min before reperfusion. On postoperative Day 5, flap survival, blood perfusion, the accumulation of reactive oxygen species (ROS), and levels of cytokines were evaluated. Histological examinations were performed to assess inflammatory cell infiltration. Results: Skin flap survival and blood flow perfusion were improved by HRS relative to the controls. The production of malondialdehyde (MDA), an indicator of lipid peroxidation, was markedly reduced. A multiplex cytokine assay revealed that HRS reduced the elevation in the levels of inflammatory cytokines, chemokines and growth factors, with the exception of RANTES (regulated on activation, normal T-cell expressed and secreted) growth factor. HRS treatment also reduced inflammatory cell infiltration induced by I/R injury. Conclusions: Our findings suggest that HRS mitigates I/R injury by decreasing inflammation and, therefore, has the potential for application as a therapy for improving skin flap survival.

Transplantation of hypoxia preconditioned bone marrow mesenchymal stem cells improves survival of ultra-long random skin flap

Background Random flap is one kind of the most widely used skin flaps in reconstructive surgery; however, partial necrosis of its distal end remains a significant problem now. The aim of this study was to evaluate the effect of hypoxia preconditioned bone marrow mesenchymal stem cells （HpBMSCs） transplantation on ultra-long random skin flap survival in rats. Methods Normoxic bone marrow mesenchymal stem cells （nBMSCs） were cultured under normoxia （20% 02） and HpBMSCs under hypoxia （1% 02） for 48 hours before transplantation. Thirty Sprague-Dawley rats were randomly divided into control group, nBMSCs group and HpBMSCs group with each consisting of 10 rats. Survival area of ultra-long random skin flap on the dorsal of rats was measured seven days after flap surgery and cell transplantation. Cell survival in vivo, microvessel density and vascular endothelial growth factor （VEGF） were evaluated by histological examination and enzyme-linked immunosorbent assay. Results Compared with other two groups, flap survival area in HpBMSCs group was significantly larger （P 〈0.05）. Microvessel density in HpBMSCs group （36.20-.8.19） was higher than that in nBMSCs group （30.01-.5.68） and control group （17.60..4.19） （P 〈0.05）. VEGF in HpBMSCs group （（300.05-.50.41） pg/g） was higher than those in nBMSCs group （（240.55_＋33.64） pg/g） and control group （（191.65..32.58） pg/g） （P 〈0.05）. Conclusion HpBMSCs transplantation improves ultra-long random skin flap survival via promoting angiogenesis of more survival cells.

Subcutaneous pedicle Limberg flap for repairing skin defects in the face

Objective:To investigate the effect of a subcutaneous pedicle Limberg flap for the reconstruction of medium-sized skin defects in the face following skin tumor or scar excision. Methods: From August 2002 to June 2004,the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients(19 flaps),and the size of the lesions ranged from 2.0 cm×1.9 cm to 5.0 cm×4.5 cm.The operation was performed under general anesthesia in 2 children,and under local anesthesia in the remaining 15 patients. Results: All flaps survived with primary healing postoperatively.With a follow-up from 1 to 22 months,neither short-term nor long-term postoperative complications such as flap necrosis,hematoma,infection,visible dog-ear and trap door deformity were found,and functionally and cosmetically satisfactory outcomes were achieved. Conclusion: This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face.

Bipedicled Mini V-Y Advancement Flap for Skin Defect of the Face

In young patients, even small circular facial defects after the excision of benign skin tumors present a reconstructive challenge. The usefulness of a V-Y advancement flap for reconstructing such defects is well documented. We refined this technique as a mini V-Y advancement flap consisting of two subcutaneous pedicles that vascularize the skin island via subdermal plexus lateral bridges. This technique was used for 21 middle-aged or younger patients with a small benign skin lesion. None of them experienced any postoperative complications. Aesthetically excellent results were found in all patients. This small advancement flap could be attempted as an alternative to fusiform excision of small skin lesions, particularly in younger patients.

腋窝皱襞切口薄皮瓣法及小切口全厚皮片法用于腋臭治疗的疗效对比

目的:观察比较腋窝皱襞切口薄皮瓣法及小切口全厚皮片法用于腋臭治疗的疗效。方法:选取2016年11月-2021年11月笔者医院行腋臭手术治疗的78例患者,依据手术方式不同分为观察组和对照组,每组39例。观察组行腋窝皱襞切口薄皮瓣法,对照组行小切口全厚皮片法。比较两组患者临床疗效、围术期各项指标、温哥华瘢痕量表(Vancouver scar scale,VSS)评分、患者与观察者瘢痕评估量表(Scar assessment scale for patients and observers,POSAS)评分及并发症发生情况。结果:观察组总有效率高于对照组,复发率低于对照组,手术时间、拆线时间、愈合时间均短于对照组,出血量少于对照组,瘢痕长度短于对照组,并发症总发生率低于对照组,差异均有统计学意义(P<0.05);术后6个月,观察组VSS、PSAS、OSAS评分均低于对照组(P<0.05)。结论:腋窝皱襞切口薄皮瓣法治疗腋臭疗效优于小切口全厚皮片法,该法复发率低,瘢痕轻,并发症少,是治疗腋臭较为理想的一种术式。